In-hospital mortality and 28-day mortality were compared.DefinitionsDuring the period after November 2005 our staff www.selleckchem.com/products/MG132.html intensivists utilized the RIFLE (Risk, Injury, Failure, Loss, End-stage kidney disease) classification to categorize the severity of AKI [6]. The AKIN classification system has since been developed to replace the RIFLE classification [7]. For this analysis, in both groups, we have applied the AKIN criteria post hoc. This system defines stage 1 as an increase in serum creatinine by 0.3 mg/dl or an increase to more than or equal to 1.5 to 2-fold from baseline or a urine output of less than 0.5 ml/kg/hour for six hours. Stage 2 is defined as an increase in creatinine by two to three-fold or a urine output less than 0.5 ml/kg/hour for 12 hours.

Stage 3 is defined as an increase in serum creatinine by more than three-fold or urine output less than 0.3 ml/kg/hour for 24 hours or anuria for 12 hours [7]. Sepsis and septic shock are defined according to previously published guidelines [8]. Shock was defined by the presence of hypotension not responsive to fluid (crystalloid or colloid) resuscitation that required vasopressor therapy. Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are also defined according to previously published guidelines [9]. In the CVVH group, the index day (T0) from which all subsequent data were recorded was defined as the day CVVH was initiated. In the control arm, T0 was defined as the day the patient met the diagnosis of AKI (AKIN stage 2) with shock or AKI (AKIN stage 3) without shock.

InterventionsPatients treated during the period prior to the availability of CVVH in the BICU received standard care for acute renal failure which included: fluid resuscitation, minimization of nephrotoxic agents, and utilization of hemodialysis if classic indications were met. These indications included: refractory acidosis, electrolyte abnormalities, symptomatic fluid overload not responsive to conservative interventions, and intoxication with a dialyzable agent. Consultation from the nephrology service was requested by the BICU intensivists when deemed necessary based on the severity of the dysfunction.The intensivists that staff the BICU have prescribed and supervised the use of CVVH since the program was started.

During the study period, patients were treated via CVVH with the Prismaflex system (Gambro, Lund, Sweden) using a polyarylethersulfone (PAES) filter, which has a nominal molecular weight cut-off of 50 kDa and a surface area of 1.4 m2. Patients were each identified AV-951 as candidates for therapy if they were AKIN stage 3 or AKIN stage 2 with shock. Typically the replacement fluid was infused both pre- and post-filter divided equally. The initial prescribed dose varied from 30 to 120 mL/kg/hour based on a compilation of various clinical parameters to include catabolic state, degree of solute and electrolyte imbalance, and presence of shock.